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ORRHES Meeting Minutes
March 19, 2001

March 20, 2001

Health
Effects Subcommittee Evaluation Report

When the member reconvened at 8:30 a.m. the following morning,
Ms. Margaret Gwaltney and Dr. Thérèse Van
Houton reported on their firm's (COSMOS) evaluation of the
Health Effects Subcommittees' process.

Three of the Health Effects Subcommittees were formed in
1995: in January at Hanford (HHES), in September at Savannah
River (SRSHES) and in December at the Idaho National Engineering
and Environmental Laboratory (INEELHES). The Fernald Subcommittee
(FHES) was formed in June 1996, and Oak Ridge's in November
2000. The HHES and ORRHES are administered by ATSDR; the
rest by NCEH (except for ~6 months in which NIOSH administered
the FHES before withdrawing from active participation with
that process). The overall charter allows for six Subcommittees.
The FHES may be discontinued, although that has not been
finally decided

At a national meeting in December 1998 of all the Health
Effects Subcommittees, an evaluation was first discussed.
All the Subcommittees selected two representatives, as did
NCEH, NIOSH, and ATSDR, to an Evaluation Work Group. They
developed a stakeholder map to show the relationships of
each to the other.

The rationale for the evaluation was to: 1) identify underlying
assumptions and expectations within and between groups,
and differences with and between the advisory committees
as well as the agencies; 2) identify features of the advisory
system that affect (facilitate/hinder) the process for reaching
and using consensus advice; and 3) develop recommendations
that address facts as well as perceptions.

The methods of the evaluation were designed and conducted
collaboratively with the Evaluation Work Group. The evaluation
was done in design and implementation phases. The Work Group
identified five evaluation questions and four crosscutting
issues. They met by conference calls every two weeks and
in person four times through the process. COSMOS joined
the work in October 1999, the Work Group began in January
1999, and the final report was submitted to CDC in January
2001. COSMOS met with each Subcommittee and spoke with as
many members as possible (>70). From an initial list
of ~100 questions which was categorized, the Work Group
developed a final list of five:

1. Are the Subcommittees effective in providing relevant
and timely advice?

2. How effective are CDC and ATSDR in using the advice?

3. What is the effect of the advisory process on the credibility
of public health activities and research, and the public's
trust in the federal government?

4. Is the advisory system helping to deliver appropriate
prevention services?

5. Is the FACA-chartered Subcommittee process the best
mechanism for obtaining public involvement?

The four cross-cutting issues were: 1) adequacy of resources,
2) role of the Subcommittees in conducting community outreach;
3) composition of the Subcommittees and rotation of members;
and 4) continuation of the Subcommittees.

The surveys were completed by 44 Subcommittee members and
14 agency staff. Semi-structured interviews were conducted
with 33 agency staff, 26 community members from the Subcommittee
sites, DOE staff, and the four Chairs. The Subcommittee
minutes and other documents were also reviewed. All the
surveys and interviews were reported anonymously. One question
was whether they believed they were exposed to radiation
or chemicals, with no specificity about whether that was
onsite to a worker and/or offsite to a population. This
question was intended to assess their perspective, since
many members felt strongly that they had been affected by
the site, and others did not. The majority of the Fernald
(60%) and Savannah River (80%) members believed they or
their family were exposed to radiation or chemicals, versus
a minority of Hanford (47%) and Idaho (33%) members. A chart
was shared outlining the characteristics of the Subcommittee
members.

Findings:
Cross-Cutting Issues

1. Adequacy of resources: 1) The Subcommittee members believe
that more resources are needed for work group activities
and community outreach; 2) Subcommittee members are concerned
that resources are not available to implement consensus
advice; 3) Subcommittee members do not understand the role
of DOE in funding recommended research and public health
activities; and 4) the agencies report that responding to
requests for information and presentations is resource-intensive.

2. Subcommittee role in conducting outreach: 1) The Subcommittee
members value outreach activities as a way to increase broad
participation in the advisory process, identify community
concerns, and communicate results of the agencies' work.
However, 2) it is not clear whether outreach is an appropriate
Subcommittee function; it is not identified in the charter.

3. Membership composition and rotation: 1) Some Subcommittees
members and agency staff are concerned about over-representation
of activists (defined as "people with an absolute, immovable
agenda") and under-representation of average citizens; 2)
many Health Effects Subcommittees members and some agency
staff oppose rotation because it results in loss of institutional
memory and it is difficult to recruit members; 3) the agencies
differ in extent to which they have enforced rotation requirements:
while ATSDR enforced them, NCEH was more relaxed.

4. Criteria for continuing or discontinuing Subcommittees:
1) In general, agency staff focus on whether the agencies
had completed their work at the site; while 2) the Subcommittee
members focused on whether all community concerns had been
addressed.

5. Interpreting the purpose/scope of the advisory process:
Two interpretations emerged: a narrow one, that advice should
be limited to current or proposed agency research or public
health activities; or a broad one (also in the FACA charter),
that in addition, Subcommittees should focus on community
concerns, recommend new studies and initiatives, and conduct
community outreach and education.

Recommendations
on Cross-Cutting Issues

Agency staff and Subcommittee members should jointly
read the FACA charter and reach agreement on the appropriate
purpose and functions of the Subcommittees.

The Subcommittees members, Chairs, and DFOs should
receive periodic training on the FACA charter.

Agencies should be consistent in implementing the provisions
of the FACA charter (e.g., member rotation). They should
also meet periodically with the Chairs and DFOs to ensure
that site-specific procedures adhere to the charter.

COSMOS' criteria for recommendations were that they should:
1) address at least one of the issues concerns covered by
the evaluation; 2) be based on data collected and observations
made; 3) be feasible - stakeholders must be able to implement
the recommendation with the available resources; and 4)
there must be a plausible connection between implementation
of the recommendation and an improvement in the advisory
process.

COSMOS
Evaluation Findings

Question 1. Are the Subcommittees effective in
providing relevant and timely advice?

Findings: In general, yes. Not all consensus
advice relates to public health activities or research;
some relates to administrative matters. (It was interesting
that some Subcommittees provided more consensus advice on
administrative issues than otherwise.) The Subcommittees
define consensus advice differently and use different procedures
for reaching consensus advice (e.g., show of hands or not
by formal votes). Not all advice is based on consensus (it
could be individual or from work groups, but if recognized
as valuable by the agencies it would be followed even without
a full Subcommittee recommendation). Most advice is not
a response to an agency's explicit request for consensus
advice; the advice is offered in the course of presentations
or discussion. Only one Subcommittee (HHES) keeps a formal
log or inventory of consensus advice.

Recommendations

1. The Agencies should develop activity-specific plans
that identify the issues on which they need consensus advice.

2. Subcommittees should establish procedures to help them
determine when and on what issues they need to provide consensus
advice.

3. Agencies and Subcommittees should collaborate on setting
goals and time lines and develop procedures that promote
accountability. Most of the Subcommittees' focus was on
a fast start and moving ahead, without a strategic plan
of what is desired to be accomplished over time. Keeping
a log to track advice over time would help.

Question 2: How effective are CDC and ATSDR in
using the advice?

The factors influencing agency decision-making related
to consensus recommendations include the availability of
resources; the agency mission; scientific soundness; and
Congressional mandates (e.g., the medical monitoring program
on which the HHES and ATSDR worked for years cannot be funded).

Findings: The agencies appear to respond
to both consensus advice and informal advice. The majority
of the advice acted on is advice related to the agencies'
current work. Subcommittee members say that sometimes they
do not receive sufficient information on why some advice
is not implemented. Subcommittee members who disagree with
agency findings have been confrontational and disrespectful
of the agency representatives.

Recommendations

1. The agency's explanation of why a consensus recommendation
is not implemented should be as complete and detailed as
possible.

The agencies need to determine whether they intentionally
accord priority to consensus advice related to current
work, and if so, they should communicate any such priorities
to the Subcommittees.

Subcommittees and agencies should have a zero tolerance
policy for personal attacks.

Question 3. What is the effect of the advisory
process on the credibility of public health activities and
research, and the public's trust in the federal government?

Findings. Most Subcommittee members believe
that research credibility has increased. For about a third,
trust in the government had increased, but for about a fifth
it had decreased. (For the balance, the trust level had
not changed; they never trusted the government. No one responded
that they had always trusted the agencies and still did,
or that it had increased). Subcommittee members report that
some members find it difficult to accept findings that do
not support their beliefs regarding health effects.

Recommendation. The agencies and Subcommittees
should jointly explore the reasons for the Subcommittees'
current lack of trust in the federal agencies, and propose
ways that trust can be enhanced.

Dr. Van Houton and Ms. Gwaltney agreed that this process
will not work as well in the absence of trust. From the
limited scope of this survey, this stood out to them as
a finding, and the Work Group agreed that this was a large
issue. Mr. Lewis asked for a definition of "trust," but
Dr. Van Houton responded that this is self-defined. It was
the hoped-for outcome of the DHHS research process from
the beginning, when DHHS was assigned this work because
DOE's credibility was not trusted. The question for COSMOS
was only to assess the change.

Question 4. Is the advisory system helping to deliver
appropriate prevention services?

Findings. There were differences of opinion
of whether "outreach" is a legitimate function of the Subcommittee.
Many on the Subcommittees believe that outreach is needed
to improve prevention services. But confusion exists among
agency staff about the appropriateness of Subcommittee outreach
activities.

Recommendation

NCEH and ATSDR should assess the value of the Subcommittees'
outreach activities and, if indicated, 1) identify outreach
as an expected activity in the next FACA charter and 2)
allocate resources to support the Subcommittees' outreach
activities.

Ms. Kaplan expressed her belief that outreach is a prime
function of this Subcommittee and reported heated related
discussions in the Communication/Outreach Work Group about
this already. Admittedly, having the public involved with
all their emotions can slow an agenda, but she felt that
this is a legitimate issue that needs to be addressed.

Question 5: Is the FACA-chartered Subcommittee
process the best mechanism for obtaining public involvement?

Findings. Most agency staff and Subcommittee
members agree on the importance of public involvement, and
more Subcommittee members than agency staff believe that
FACA is the most appropriate mechanism for obtaining it.
(Some agency staff were frankly worn out by this process
and were unsure that FACA was the most appropriate method
to get public involvement, noting that there are other ways
to do so, such as community meetings, work groups, etc.
But in 1995, there was strong feeling to have the FACA process,
and that there was value in having the agency consistently
meet with the communities). Agency staff and Subcommittee
members have different criteria for discontinuing a Subcommittee.

Recommendation. The agencies and Subcommittees
should acknowledge from the beginning that the Subcommittees
will eventually end, and plan early on for their discontinuance
and for sustaining public involvement afterward.

Final Finding: This evaluation is a first
step. The evaluation's findings suggest ways to improve
effectiveness and accountability.

Final Recommendation: CDC and ATSDR,
in collaboration with the Subcommittees, should continue
to evaluate and assess the effectiveness of the Health Effects
Subcommittee advisory process.

Subcommittee discussion with the COSMOS representatives
included the following:

All parties should read the FACA charter together to
reach agreement on the narrow or broad interpretation
of the committee's function. If they begin with different
interpretations, it is likely they will proceed in different
directions.

Mr. Lewis agreed that without time lines and implementing
procedures, the Subcommittee cannot gauge progress and
success. A method should be agreed upon from the start.

What are the 3-4 most important things this Subcommittee
should resolve at this time to avoid future trouble?
(Brooks) Discuss why the members are involved and what
they want out of this process, find the common
goals; then agree what the Subcommittee wants to accomplish
and track it along a time line to assess progress (advice
given, agencies' response). If the advice is not implemented,
ask why, to avoid a vague feeling of dissatisfaction
that the advice is not being taken.

We need a thorough discussion of our mission statement
during the agenda so we know how to proceed. (Sonnenburg)
Ms. Sonnenburg noted that ATSDR's mission includes health
education, which immediately seemed to be the thrust
of their work at Oak Ridge (e.g., the GWU contract).

Agreed; perspectives are different. Some have an agenda,
such as what is right for this community, and ATSDR's
scope does not meet that, other agencies, foundations,
etc. need to be found to do so. Putting that in a bureaucratic
jangle of rules and regulations is a formula for conflict.
(Kaplan) Such conflicts will compromise the individual
member's and the Subcommittee's effectiveness. Discussion
of this was encouraged.

Please elaborate about the FHES' situation. (Akin)
NCEH finished their work and turned the Subcommittee's
lead over to NIOSH, which was still working on site.
Shortly thereafter, NIOSH decided that their mission
to serve the workers was better pursued than through
a public FACA vehicle and they returned it to NCEH.
But the Subcommittee feels that there are still unanswered
concerns, and they are working on another structure
to take the FHES' place.

Has any group developed a program with logic and process,
decision models, etc., to develop and give consensus
advice? (Lewis) Each committee developed operational
guidelines, but encountered some problems when the agency's
committee management found conflicts with their charter.
They exist, but are not well used. There was no training
or tool kit provided, except for the joint 1998 meeting.
But bringing all the members to one place was
very costly, limiting how often that can be done. (Dr.
Davidson noted that the ORRHES' procedures and guidelines
became its by-laws, so there should be no conflict with
committee management.)

Why would the Subcommittees frustrate themselves by
recommending on things the agency cannot do? Someone
isn't doing their job. (Frome) Some refusals were unanticipated;
for example, the Hanford Medical Monitoring Program's
funding was denied at the DOE and Congressional level,
not below. Why won't Congress fund it? (Kaplan) The
HHES would like to know that too. The Subcommittee should
work with its colleagues at ATSDR to learn all they
know of it.

We should consider communication between the Subcommittees;
it would most likely be helpful. (Pardue)

Were there individual recommendations for the Subcommittees
different from the overview? (Davidson) The blinded
data specific to the Subcommittee was included in their
report, but no separate recommendations. The evaluation
was of the entire advisory process, not each Subcommittee.

How do we build on this information? ATSDR is planning
a meeting of the Subcommittee DFOs on May 17-18 to review
these recommendations and take them to the next step.

What agency funded this very well done study, and was
it a competitive proposal? (Pardue) NCEH's budget funded
it, and it was guided by the Work Group. COSMOS has
a Task Order contract with DHHS that was competitively
awarded.

What was the agencies' response to the report? (Lewis)
After incorporation of the Work Group members' comments
provided in December, COSMOS turned in the report to
CDC/ATSDR in January and briefed agency staff and upper
management. They received it positively.

Which, a broad or narrow interpretation, would benefit
this Subcommittee most? (Johnson) COSMOS could not say;
that needs to be resolved by the Subcommittees and the
agencies together. Both views exist in both arenas,
although the agencies generally more reflect the narrow
interpretation.

Dr. Davidson recommended a facilitated discussion of why
the members participate individually, and the individual
and collective goals and expectations of the Subcommittee;
how those fit with ATSDR/CDC; how to envision and track
the ORRHES' progress and accomplishments, and what benchmark
to use to track progress. She asked the Agenda Work Group
to work on that. She also wished for an evaluation of the
ORRHES, hopefully by the September meeting but not later
than the December meeting.

Ms. Kaplan recommended Ms. Linda Lewis as the facilitator
and Ms. Dalton responded that ATSDR will consider that.
Dr. Eklund noted that several times the work groups were
referred to as Subcommittees, which is confusing, and asked
that they be consistently referred to as Work Groups.

Public
Comment

Mr. Bert Cooper, of ATSDR's Division of Health Assessment
and Consultation, complimented COSMOS on their presentation.
He stated that their recommendations are now before the
senior managers at CDC and ATSDR, and anticipated that the
recommendations will be well received. The DFO/Chair meeting
also may lead to another national meeting such as was held
in Salt Lake City.

Ms. Linda Lewis suggested that something be facilitated
on how the Subcommittee interacts and relates with DOE and
others, as related to the concept of trust, and expressed
her enjoyment of the opportunity to interact with the Subcommittee
on the previous evening. She cited Steven Covey's "Seven
Habits of Highly Effective People", and its list of five
things to propel people through life with a purpose and
to create one's own destiny: live, love, learn, laugh, and
leave a legacy. She advised again that the Subcommittee
knock on the doors that can open, not those that will not.

Mr. William Carter, of ATSDR's Division of Health Education
and Promotion (DHEP) and the AOEC technical project officer
for site work, reported having been present at many sites
were HRSA and ATSDR were raised. He advised against raising
unrealistic expectations. HRSA places clinics in communities
that are medically underserved, and their book of guidelines
and criteria to do so are extensive. So far, ATSDR has not
found a single community that fits their criteria. He suggested
that the Subcommittee consider inviting HRSA to the meeting
to explain those criteria. He added that the needs assessment
is being done by one of the DHEP Branches, whose staff will
return in future to discuss the Phase II work.

Mr. Jerry Pereira stated that Ms. Dalton, in collaboration
with Dr. Davidson, will maintain the same log as HHES'.
He agreed that the agency should ask for consensus recommendations
for milestones and goal-oriented tasks. And, regarding outreach,
he stated ATSDR's good-faith effort to have the community
well represented by the Subcommittee's membership. One area
in which the outreach could begin could be to develop a
fact sheet with ATSDR.

Presentation
of the HHES Web Page

Ms. La Freta Dalton projected the title page of the HHES
Website for the consideration of the ORRHES home page suggested
by some members. The HHES site posts its brochure; committee
roster and brief biographies in English and Spanish; meeting
agendas and presentations; Frequently Asked Questions; minutes
(downloadable in html or pdf files) and other Subcommittee
materials; links to other agencies, citizen and tribal groups;
and links to other studies done (for example, the Hanford
Thyroid Disease Study); maps of the Hanford site itself
and its relationship to surrounding communities; and a What's
New section with sub-topics below.

Drs. Frome and Brooks volunteered to help built the site,
which is being coordinated through the Communications/Outreach
Work Group, and distributed a one-page summary of what might
be included on a Website. Dr. Frome expected that many maps
of Oak Ridge already exist that can be linked to. He asked
who would support the work. Ms. Dalton thought that ERG
would most likely conduct the needed conference calls, but
first a map of the site's content has to be done. ERG will
help develop it and it will placed on the CDC server. Ms.
Kaplan asked for volunteers for the Communication and Outreach
work group. Volunteers were Hill, Creasia, Brooks, Frome,
Sonnenburg, and Kaplan. Dr. Davidson confirmed that a Subcommittee
member can serve on multiple work groups; they are expected
to know their own limitations.

Work Group Reports

Agenda Work Group.

Dr. Brooks provided an advance notice of the June meeting
agenda, and the Agenda Work Group's program of work (Attachment
#7). The Agenda Work Group provides input to Dr. Davidson,
who advances it on to ATSDR. They return a draft agenda
for Work Group review and then ATSDR prepares/distributes
the final agenda. The Work Group meets twice to review the
members' or Chair's agenda suggestions and then again to
review the draft agenda to send to ATSDR. There might be
interim communication if the Chair suggest special topics.
Dr. Brooks suggested that the meeting start/top times be
firm; otherwise the agenda can be flexible. There were no
comments offered on this process.

A broad overview of what the Work Group may do in a Program
of Work for the next 2-3 years was provided to the Subcommittee.
Input is still needed from ATSDR on the public health assessment
and Health Needs Assessment components. Dr. Brooks moved
that the program of work be adopted as submitted, recognizing
that it is a living document subject to change, for the
use of the Work Group in delineating its future plans.
The motion was seconded.

Dr. Frome offered an amendment to add to the motion to
Put the program of work on the Website when set
up, and with last update date. The amendment was
seconded. All were in favor of the amendment

Further discussion on the main motion included:

Dr. Creasia wondered about the utility of the agenda,
since it is a draft until the day of the meeting and
can be changed at any time. Ms. Dalton responded that
this is done to allow some flexibility if something
important arises that needs to be addressed. The draft
is published to let the community know when something
that they are interested in will be addressed; and often,
it is not changed.

Ms. Sonnenburg and Mr. Hill realized that the Work
Group had discussed this plan, but had not adopted it.
Dr. Brooks agreed that it was not voted upon. The Work
Group discussed the need for a program of work, and
this was circulated. He expected this document to be
modified relatively frequently in the next few weeks
and offered it to serve as a base so that the discussion
would not need to be renewed each time.

Ms. Sonnenburg noted that the Chair had asked the Agenda
Work Group to discuss its purpose and program of work.
She moved to table the main motion to the next
meeting, to consider it as a working document at the
next meeting. Mr. Johnson seconded the motion.
In discussion, Dr. Eklund opposed the postponement,
since this is a living document. Adopting it would remove
it from draft status and allow work on only the sections
to be modified. Dr. Davidson commented that the advantage
of postponing would be to first allow the facilitated
discussion of the Subcommittee's overall goals and purpose.

A vote on the motion to table revealed
three in favor: and 11 opposed. The motion failed.
A vote on the main motion to adopt the
program of work revealed 14 in favor and none opposed. The
motion passed.

Procedures
and Guidelines Work Group

Dr. Davidson reported on changes made to the Bylaws document
since the January meeting (Attachment #8). The Work Group
recommended that:

1. Since the bylaws are now a self-contained document of
itself, that the procedures and guidelines be an appendix
to it.

2. All bylaws derived from FACA requirements, GSA rules,
or the Subcommittee charter will be identified by an asterisk
and footnoted to indicate they cannot be changed.

3. Information on work groups was consolidated under one
article (Article IX).

4. Changes were made to indicate that the Subcommittee
can meet by conference call if published in the Federal
Register and open to the public.

5. The general order of business was modified according
to Subcommittee recommendations (including the public comment
period).

6. Article X, Section 6 was added to specify that all major
recommendations require a two-thirds affirmative vote at
the meeting to indicate consensus.

What constitutes a "major recommendation"? What is
not one, for example, is an action item to have the
ATSDR provide materials. If it is disputed, and is not
advice to ATSDR, a simple majority vote decides.

Is the conference call an option for a regularly scheduled
Subcommittee meeting, or limited topics? It is for emergency
situations.

When can and cannot a member discuss Subcommittee matters
with the media? Ms. Kaplan had written a letter to the
editor and sent it in courtesy to Ms. Dalton, although
it concerned a matter discussed and voted on in the
meeting. Ms. Dalton responded that when she considered
this issue, she felt that it needed to be addressed
within the Subcommittee itself. Dr. Davidson stated that
the letter's subject matter had been brought to a Work
Group, not the Subcommittee, and should not be discussed
with the media until the overall Subcommittee is finished
with addressing it. Members will disagree, but to do
so in public will be self-defeating. The Subcommittee
cannot restrain individual members, but it is left up
to the members to be careful to not confuse the public
about where the Subcommittee's opinion lies as opposed
to that of an individual. The Subcommittee as a whole
will be issuing information to the public.

Ms. Kaplan moved to amend Article 10, Item 13 (regarding
observers' comments only at specific times) to modify
the first sentence to state "...unless the Subcommittee
allows an observer to speak." Dr. Davidson favored that
if the comment were a technical one, but did not want
to confuse the public of when the formal public comment
period is. However, Ms. Sonnenburg supported the motion.
If an issue has been discussed and the members are ready
to vote, relevant public input should be allowed before
the vote is taken. Ms. Lewis also advised flexibility
in working with the public, but Mr. Johnson commented
that keeping the agenda on time could be a challenge,
given enough interruptions.

Other comments included:

Accept the bylaws first, then make changes.

Delete "expertise" since many issues the Subcommittee
addresses will deal with emotion and perception. The
public should be able to comment on anything as long
as It is germane to the issue.

There should be sufficient control to allow germane
comments, but perhaps this should be in the section
about solicitation of experts instead (Article 4,
Section 5), to allow comment by a "technical expert
or a person with information germane to the topic".

That is acceptable, but also amend #13, and leave
out the word "only;" retain that observers may speak
in the public comment period.

A vote was taken to rewrite Article
4, Section 5: "Non-members may be granted the privilege
of full participation (except voting) in the discussion
germane to the topic by a simple majority vote of
the Subcommittee."

- Ms. Mosby thought the Bylaws are addressing too much;
such details should be on the procedures and policies, which
are easier to revise. But, since the Work Group had already
addressed this and time was pressing, Dr. Davison called
for a vote. Eleven were in favor and four opposed. The
motion passed. Similarly, a vote to amend
Article 10, Section 13, to delete the word "only"
revealed 13 in favor and two opposed. The motion
passed.

Dr. Frome moved to add that the Bylaws be posted
on the ORRHES Website, when available, with links when appropriate.
The motion was seconded and unanimously adopted.

Dr. Brooks moved to adopt the bylaws as changed
by the previous motions. The vote was 13 in favor:
and two opposed. The motion carried.

Communications/Outreach
Work Group

Ms. Kaplan pointed out the changes to the Communications/Outreach
Work Group's purpose and statement of work (correct copy
2/12/01, Attachment #9). Mr. Hill moved to adopt
the amended documents. The motion was seconded;
with 13 in favor and none opposed, the motion carried.
Ms. Kaplan pointed out that the proposed communications
strategy would replace "MP" with "Designated Federal Official"
and delete the parenthetical example (e.g.,...). The
amended communications strategy was adopted with
12 in favor and none opposed.

Ms. Kaplan reported several more items:

She noted that the article "Inconclusive By Design"
and ATSDR's related comments were distributed. She appreciated
that ATSDR had taken some action to address the issues
raised in that paper.

She reported having received a personal e-mail letter
from Peggy Atkins suggesting ways to better communicate
with the public. Ms. Kaplan responded, and asked her
permission to forward it to the work group/committee.
Dr. Davidson suggested that the Work Group also provide
a formal response.

Mr. Washington asked why. The members were chosen
to reflect the wide, outspoken, honest different views
of the public. Consensus need not be achieved on every
item discussed; that is why votes are taken; and minority
opinions can be included if desired in the final document.

However, Mr. Johnson raised the members' implicit
mission to educate the community as well. It will be
a major job to rebuild credibility with the community;
they should be involved in such a workshop as well.

Dr. Davidson noted that this could be a way to learn
a mechanism to help draw out the quieter members. She
found agreement to refer this back to the Work Group
for a recommendation at the next meeting.

Ms. Kaplan distributed for the members' consideration
a proposed mission statement for the ORRHES date 3/17/01,
in anticipation of the next meeting's discussion. She
clarified for Mr. Manley that non-Cold War worker residents
refers to the residents who are not covered by programs
in place to address the workers needs.

Health
Needs Assessment Work Group

Ms. Mosby raised the need to redefine the Work Group's
work, as discussed on the previous day, and return with
that for discussion in June. She requested any other suggestions
for the key informant list or the focus group list (Attachments
4/5). However, Dr. Malmquist requested immediate action.
The Work Group had reviewed a map and outlined the areas
they suggested should be covered by the telephone survey.
It reduced the potential population from 700,000 to 200,000.
Ms. Sonnenburg moved to adopt the map as the area
for the phone survey, to allow discussion. Dr.
Malmquist seconded the motion. The Subcommittee took a short
break to allow all the members to review the map. On reconvening,
Dr. Malmquist volunteered to re-draft and form a boundary
in document form to follow the outline on the map.

Committee discussion included:

Mr. Pardue supported this as a sound and good approach.
The areas should include everyone who have a technical
justification for being included. He had been uncomfortable
with his vote to drop Blount County since that decision
was made, because it has many resident workers as well.

Mr. Hill agreed, and wished for community comment before
the vote.

Dr. Creasia asked that a summary of the rationale be
part of the record with the map.

Mr. Manley asked what contaminants were considered.
Dr. Malmquist identified iodine and wind flow (the reason
part of Blount and Knox counties were included) and
for liquid flow, all the areas to the Watts Bar Dam.

Mr. Lewis stated that the Group used the pathways identified
by Mr. Hanley as potential exposures and consulted with
experts, and supported Mr. Pardue's comment. He also
felt more comfortable with the area now.

On a another Work Group matter, Dr. Brooks moved
that the Subcommittee approve the Work Group's list of key
resources to send to ATSDR, to be advanced to George Washington
University for compilation by GWU, with additional input.
Ms. Sonnenburg commented that this was Dr. Brooks'
own list, and that there was no need to vote on a list this
day. Mr. Lewis suggested slowing down and not rushing. Dr.
Davidson agreed that an emergency meeting could be held
if needed. Mr. Lewis asked Dr. Parkin to clarify the groups
of people suggested. She identified the three categories
as health care providers and community members knowledgeable
of health matters, and health officials at any level, for
the focus groups. Physicians and Health department personnel
could also be covered in the key resource interview phase.
On a vote, three were in favor and 11 were opposed. The
motion failed.

Dr. Davidson referred the list back to the Healths Needs
Assessment Work Group for further refinements, and expected
to call an emergency meeting after April 23. The
Subcommittee agreed to hold a conference call at noon on
April 24th to review the list. A meeting site for
those who can meet will be selected and conference call
arrangements will be made.

Ms. Theresa NeSmith of ATSDR noted that the names on the
list generated will be part of the public record. For that
reason, at least twice as many names as needed would be
required to preserve confidentiality. If only a few are
listed, everyone will know who is chosen.

Unfinished
Business

Report on EPA Sampling.
Ms. Cheryl Walker-Smith, Remedial Project Manager, reported
on the status of media sampling done by EPA in Scarboro.
It was put on hold due to EPA's priority of working with
the Department of Justice on the Paducah issue. An Interagency
Work Group was established to address not only sampling
in the Scarboro community, but to prepare a work plan for
sampling offsite for the entire Oak Ridge Reservation. A
meeting to do so was held on February 22, 2001, with participation
by DOE, TDEC, the Tennessee Health Department, ATSDR, and
EPA. EPA would like the ORRHES to review the sampling plan.

The committee's comments included:

How long do you think it would have taken to do the
Scarboro work? (Lewis) Man hours were not the issue;
it was that the one person assigned to Scarboro was
reassigned to Paducah. It might only take 2-3 days.
The EPA also has had comments about focusing so much
of its work only on Scarboro.

When will you start? (Manley) That has not been decided;
a work plan has not even been drafted yet. EPA has to
do that first. EPA will keep this Subcommittee updated
when activities are planned.

Are there plans to meet again before our June meeting?
(Davidson) Yes, but no date has been set. The ORRHES
will be notified if it occurs before the June meeting,
so that they can schedule a progress report.

Geographic area of
interest/phone survey: Mr. Pardue moved
that the Subcommittee formally accept the map for the telephone
survey area, including Blount County. Mr. Washington
seconded the motion, and a vote showed 14 in favor and two
opposed. The motion carried.

Seating a DOE Liaison.
The Subcommittee held a discussion of the question of seating
a DOE liaison, which was raised at the last meeting. The
Subcommittee's comments included:

Neutral view: The Subcommittee needs facilitation to
help examine the trust issue with DOE (Lewis); I cannot
trust the bureaucracy, but there are individuals who
can be trusted. The issue is, will it hurt the ORRHES'
credibility? (Kaplan)

Positive view:

EPA, ATSDR, and CDC have all been mistrusted as well.
Trust needs to be developed. The Subcommittee cannot
ask the public to trust DOE if it doesn't even trust
them to sit at the table. DOE is a major player in
all the issues of importance to the Subcommittee and
will be here long after DHHS leaves. They should be
seated. (Brooks)

The current staff are trustworthy; the best way to
solve a problem is to talk about it. (Pardue)

There are many kinds of trust; for example, to be
open, honest, do the right thing, answer questions,
or push the envelope on what Congress allows. Perhaps
these cannot all be achieved, but they need to be
teased out. Some mistrust is due to misunderstanding.
DOE should be seated to address what can be addressed.
(Akin)

Mr. Joseph has attended every meeting, and could
give direct input and be more available to the Subcommittee
seated at the table. (Davidson)

Negative view:

Trust comes from behaving/acting as say you will.
DOE has begun to come around, but not enough for the
community to forget past grievances. Due to that past
history and lingering doubt, they should not be seated.
(Eklund)

With them formally present, people will not speak
honestly about things they know occurred. (Washington)

Tim Joseph does a fine job of supporting the Subcommittee.
But there will be those in the community who will
never believe the results of the Subcommittee's work
as long as DOE is at the table. The support needed
can be obtained without them on the Subcommittee.
(Craig)

The issue is not so much the Subcommittee's mistrust,
but the community's. If it does not gain the ORRHES
anything, but costs it the community's confidence,
DOE should not be seated. Community input was requested.
(Hill)

Dr. Brooks moved the Subcommittee make a minor
recommendation of seating the DOE liaison to ATSDR,
in which the majority voted in favor and the minority were
opposed. Several member objected that this was not a minor
decision. Ms. Sonnenburg moved to table the motion
to seat a DOE liaison to the ORRHES to the next meeting,
and suggested that the Procedures and Guidelines Work Group
develop a definition in writing of what constitutes a major
and minor recommendation. The motion was seconded,
and in a voice vote, those in favor carried the motion over
two opposed. Vote to table carried.

New
Business.

Mr. Bill Murray, ATSDR's liaison in Oak Ridge, provided
the phone and address of the ATSDR office: (865) 220-0295;
(-0457 for fax), at 197 South Tulane Avenue. The hours are
12-7, Monday-Thursday; and 7-3 on Friday. The office could
be open another evening from Tuesday to Thursday as well.
Mr. Lewis liked that idea, since the Subcommittee had been
criticized for holding meetings during "office hours.

Mr. Murray asked for a preference on hours (11-7 or 12-8),
and what other evening than Monday the office should be
open. Dr. Davidson noted that most Work Group meetings are
on Tuesdays. Dr. Brooks felt there was no need to expand
the hours without support services. He lamented that the
copier is inadequate to produce materials for meeting such
as this or even work groups; there is no supply support;
chairs, tables, shelf space, and reading materials are missing;
and the computer system is not up to par. He recommended
that ATSDR look at how it is supporting its office. Dr.
Brooks moved that ATSDR in a timely manner upgrade
the field office's resources available for the Subcommittee
and public's use. Mr. Pardue seconded the motion.
Dr. Frome asked that the general resources include good
maps, and Mr. Murray welcomed all suggestions of needed
material. On a vote, 14 were in favor and none were opposed.
The motion passed.

Mr. Murray then suggested that the members take some off-site
tours of the ORR area at each of the next three meetings
(June, September, December). Mr. Joseph had offered to facilitate
a "windshield tour" to make the members familiar with the
geographic area.

Committee comment included:

It would be better to read about it than to just drive
by. Get a pass and bus through. (Hill) It is very easy
to get on the reservation; a pass only requires name,
affiliation, and purpose. (Galloway) Mr. Joseph agreed;
only Y-12 is a challenge to enter.

Dr. Brooks thought the tour could take only two hours,
as done for GWU. But Mr. Murray responded that they
did not need the same degree of understanding about
the site. A tour of the ETTP, K-25, and X-10 could be
done, but he preferred the logistics of a separate tour
to taking 2-3 hours out of the meeting time.

Dr. Davidson suggested that Mr. Murray work on a plan
for a tour of 1-2 sites (no preference) at the next
meeting.

Finally, Mr. Murray reported that having received a
memo from the Oak Ride Institute for Science and Education
that they would present the first "State of ORISE" report
in Pollard Auditorium, Thursday, March 22, at 5:30 p.m.
They will present ORISE's past activities and future
plans.

Public Comment
was solicited to no response. Dr. Davidson reiterated that
call several times in the next half-hour.

Mr. Pardue asked Mr. Stewart if the recent legislation
passed to compensate workers helped at all. Mr. Stewart
figured that it would help about 50, out of the 181,000
current and former workers, who have one of the 11 specified
types of cancer, including berylliosis and silicosis. Mr.
Hill reported ongoing discussion about this, which takes
effect in July. The worker advocacy group at DOE Headquarters
has received different answers about whether this is the
sole source and only opportunity for redress. That is of
concern, because it appears that this program would eliminate
the previous option of litigation or compensation by other
state or federal programs.

Mr. Lewis asked if there is any avenue for the worker's
voice other than NIOSH. Mr. Stewart said that the DOE-funded
worker medical survey is the most positive thing to date,
demonstrating the need. It will provide a Catscan at the
union hall; there already is a backlog on that of 1000 people.
They can do 140 scans a week; and only have it for two weeks.
The Catscan is able to detect a lung cancer about two years
before it appears.

Ms. Kaplan commented that the Workers' Compensation Act
does not mean that everything is settled. The Radiation
Exposure Act was passed in 1990 to compensate workers exposed
from 1941-1971, but many workers or their surviving families
have not yet received any compensation. Without Congressional
appropriation of the necessary funding, the legislation
is meaningless.

Housekeeping/Closing
Comments

Participation in the work groups has been very low, Dr.
Davidson noted. The Bylaws require a quorum of work group
members to do a work group's business. She asked members
unable to participate, to remove their name from the roster
to allow the quorum to be accomplished. She asked that the
Chair be notified if a member cannot attend a particular
meeting; a conference line could allow dial-in participation.

Quorum. She also reminded the members that a quorum must
be maintained while the Subcommittee is in session and discussion.
Copying Materials. Copying charges are very high at the
mall. Dr. Davidson asked that materials be provided before
Ms. Palmer leaves Atlanta, which will also allow them to
be put in the meeting folders in agenda order. She advised
the members, on Ms. Mosby's question, to check with Mr.
Murray on how to deal with copying and purchasing materials
for the Work Groups.

Consultant fees: Ms. Palmer reported having worked with
the Personnel Department to arrange for consultant fee payments
to be caught up after this meeting. She asked the members
to call her if that had not occurred after a few more weeks.

Work Group meeting schedules Ms. Dalton asked the members
to let Mr. Murray know when work group meetings are scheduled
so that he can attend as the ATSDR representative, as required
by FACA.

With no further comment, the meeting adjourned at 3:54
p.m.

I hereby certify that, to the best of my knowledge, the
foregoing Minutes are accurate and complete.

Kowetha A. Davidson, Ph.D., Chair

Attachments:

Letter from Ms. Janice Stokes

Public solicitation for nominations

Table 3-5 assigned all the table 3 contaminants to
pathways

Telephone survey modified submission from GWU

Characteristics of focus groups

Key resource groups/individuals list

Agenda Work Group Program of Work and advance copy,
June meeting agenda

Changes made to the Bylaws document

Changes to the Communications/Outreach Work Group
Purpose and Statement of Work (correct copy 2/12/01)

Motions Passed, ORRHES March 19-20,
2001 Meeting

Action items list

Attachment #10

Motions Passed, ORRHES
March 19-20, 2001 Meeting

Dr. Craig moved to form a Public Health
Assessment Work Group. Work Group volunteers were: Johnson,
Craig, Brooks, Manley, Washington, Lewis, and Kaplan.

Dr. Brooks moved that the Subcommittee
recommend to ATSDR that a minimum of 7 and maximum of 11
Subcommittee members participate in a pilot test with George
Washington University to determine the appropriateness of
the survey questions.

Dr. Brooks moved that the Needs Assessment
Work Group choose the 7-11 members, the majority wishing
to participate to be selected from the Work Group and the
balance from the Subcommittee. Work Group volunteers were:
Vowell, Sonnenburg, Johnson, Galloway, Brooks, Creasia,
Hill, Malmquist, Kaplan, Lewis, and Mosby.

Ms. Mosby moved that the Subcommittee accept
the Work Group's recommendation to identify George Washington
University's Step 4 as the Key Resource Group, Step 5 to
be the Telephone Survey and Step 6 to be the Focus Groups.

Dr. Brooks moved that the program of work
be adopted as submitted, recognizing that it is a living
document subject to change, for the use of the Work Group
in delineating its future plans. Dr. Frome offered an amendment
to add to the motion to put the program of work on the Website
when set up, and with last update date.

Ms. Kaplan moved to rewrite the Bylaws'
Article 4, Section 5: "Non-members may be granted the privilege
of full participation (except voting) in the discussion
germane to the topic by a simple majority vote of the Subcommittee."

Dr. Frome moved to add that the Bylaws
will be posted on the ORRHES Website, when available, with
links when appropriate.

Dr. Brooks moved to adopt the bylaws as
changed by the previous motions.

Mr. Hill moved to adopt the amended documents
of the Communications/Outreach Work Group's purpose and
statement of work (correct copy 2/12/01). Similarly, Ms.
Kaplan moved to accept the amended communications strategy.

Mr. Pardue moved that the Subcommittee
formally accept the map for the telephone survey area, which
includes Blount County.

Ms. Sonnenburg moved to table the motion
to seat a DOE liaison to the ORRHES to the next meeting,
and suggested that the Procedures and Guidelines Work Group
develop a definition in writing of what constitutes a major
and minor recommendation.

Dr. Brooks moved that ATSDR in a timely
manner upgrade the field office's resources available for
the Subcommittee and public's use.

Attachment #11

MARCH, 2001 ACTION ITEMS LIST

ATSDR will report on the dose reconstruction feasibility
study report's consideration of the potential cumulative
effect from other radiation sources (e.g., NTS).

ATSDR will present the findings of the technical review
of the dose reconstruction feasibility study (and if
those comments were addressed), and then discuss next
steps; and will provide copies of correspondence with
Dr. Kathleen Teeson regarding fluorine.

Dr. Frome asked that the peer review status be specified
for any material provided to the Subcommittee.

The Public Health Assessment Work Group will discuss
with ATSDR, in developing the plans for the public health
assessment, concerns expressed about peer review, limestone/water
contaminant transport, carbon tet, depleted uranium,
and other issues raised.

HRSA could be invited to describe what they can do
in terms of opening an area clinic.

The Agenda Work Group was asked to explore facilitation
for a Subcommittee discussion about why the individual
members are participating, their goals and expectations
(individually and collectively); how those fit with
ATSDR/CDC's work; how the Subcommittee interacts and
relates with DOE and others as relates to the concept
of trust; and how to envision and track (with what benchmarks)
the ORRHES' progress and accomplishments.

Dr. Davidson would like an evaluation of the Subcommittee,
hopefully by the September meeting but not later than
the December meeting.

The DHEP Branch doing the Needs Assessment will return
in future to discuss the Phase II work.

Several things were asked to be placed on the Website,
when implemented.

The Agenda Work Group will discuss its purpose and
program of work. The updated working document will be
held as the primary material to be used for discussion
at the next meeting.

Ms. Kaplan's proposed mission statement (3/17/01) for
the ORRHES was provided for the members' consideration
in anticipation of the next meeting's discussion.

The Health Needs Assessment Work Group will re-draft
and form a boundary in document form to follow the telephone
survey that was outlined on the map during this meeting.

ATSDR will send the action items list to the members.

A conference call will be held at noon on April 24th
to review the key informants list. A meeting site for
those who can meet will be selected; and conference
call arrangements will be advised.